Provider Demographics
NPI:1770081630
Name:DELYNN M. SHATTUCK, DDS, PC
Entity type:Organization
Organization Name:DELYNN M. SHATTUCK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SHATTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-790-3400
Mailing Address - Street 1:5382 GRATIOT RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6035
Mailing Address - Country:US
Mailing Address - Phone:989-790-3400
Mailing Address - Fax:
Practice Address - Street 1:5382 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6035
Practice Address - Country:US
Practice Address - Phone:989-790-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty